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Creating Better Pain
Management through Clinical
Simulation
Hollie Adejumo
Howard High School
What is Pain?
An "unpleasant sensory and
emotional experience
associated with actual or
potential tissue damage, or
described in terms of such
damage.“
-The International Association for the
Study of Pain

                                         http://health.howstuffworks.com/diseases-conditions/pai
Types of Pain
 Acute or Transient pain
 Chronic or Persistent Pain
 Cancer Pain




                 http://health.howstuffworks.com/diseases-conditions/headache/10-
                 types-of-headaches.htm
Methods of Managing Pain
• Internal Procedures
• Medication
• Therapy
• Alternative
  Therapies
• Counseling and
  Support
                          Acupuncture is a common
                          alternative method for relieving pain
                        http://health.howstuffworks.com/wellness/natural-medicine/chinese/acupuncture.htm
Measuring Pain
“Pain is whatever the experiencing patient says it is,
  existing when she/he says it does” –McCaffery and
  Pasero (1999)


   Patient’s Perspective:
    ◦ Demands physical, emotional, and mental
      energy
   Provider’s Perspective:
    ◦ Assessed by looking at a patient’s report, not
      the predicted signs and symptoms
    ◦ Patients tells if pain is present and what it is
      like
Types of Pain Medication
 Non-Opioid Analgesics
 Opioid Analgesics
Effective Pain Management



           http://www.wllc.com/blog/preventing-medication-errors.cfm




 Combine opioid and non-opioid
  pharmaceuticals
 Timely administration
Patient Concerns
 Psychological Dependence
 Drug Tolerance
 Physical Dependence
 Addiction
Effective Pain Management and
Considerations
   Understand a patient’s cultural
    differences in pain expression
    ◦ Different cultures may have different ideas
      of the meaning of pain
   Assess the meaning of pain to a
    patient
Pain Assessment Tools
 OPQRSTU
 Pain Scales




                http://savvypatient.org
OPQRSTU of Pain
Assessment
O   nset
P   rovocative/Palliative Factors
Q   uality (Open Ended Questions)

R egion/Radiation
S everity
Timing
U You
    “How does pain affect you?”
Pain Scales
 Numerical Rating
 Wong-Baker
 Verbal Rating
 Observer Scales
Numerical Rating Scale




   http://understandingpain.wordpress.com/category/pain-assessment-tools/
Wong-Baker Scale




   http://understandingpain.wordpress.com/category/pain-assessment-tools/
Verbal Rating Scale- McGill Pain
Questionnaire




            http://pain.about.com/od/testingdiagnosis/ig/pain-scales/McGill-Pain-Scale.htm
Observer Pain Scales




     http://0.tqn.com/d/pain/1/0/V/-/-/-/FLACC.gif
Using Pain Scales to Make
Decisions about Pain Medication
 Pain Scales make the pain
  measurable
 Helps to determine if pain is mild,
  moderate, or severe
 Makes it easier to find an effective
  dose
Factors Considered when
Determining Medication Dosage
 •   History of a patient’s pain
 •   Pain intensity
 •   Duration of Pain
 •   Aggravating and Relieving Conditions
 •   Determine the cause of the pain
Clinical Simulation-Based
Training
   “Simulation is a technique – not a technology –
    to replace or amplify real experiences with
    guided experiences that evoke or replicate
    substantial aspects of the real world in a fully
    interactive manner.” – David M. Gaba, Stanford
    University
   Examples:
    ◦ Standardized Patients
    ◦ Mannequins
    ◦ Computer-Based Simulation Used to build a safer health
                                     system by providing guided
                                     practice
                                    http://blog.hospitalclinic.org/en/2009/05/nou-laboratori-de-simulacio-
                                    clinica-de-la-facultat-de-medicina/
Benefits of Clinical Simulation



           http://www.temple.edu/ics/programs/medicine/fy2.html




• Provides a variety of real-life situations
• Opportunity to repeatedly practice without
  real patients
• Convenient
• Active learning and Concentration
• Increases collaboration within medical
  teams
Standardized Patient
                                                  •An actor trained to portray the role of a
                                                  patient, family member, or another
                                                  individual
                                                  •Simulate in a standardized manner
http://www.temple.edu/ics/about/standardized.ht
ml




                                                  http://www.hopkinsmedicine.org/simulation_center/training/standardized_patient_program/index.
                                                  html
Resident Problems with Opioid
Decision Making
 Lack of Confidence
 Poor Interviewing Technique
 Lack of Opioid Knowledge
 Poor written orders for medication
 Inconsistent use of drug calculations
  to determine drug doses
Improving Opioid Decision
Making with Clinical Simulation-
Based Training
   Goals:
    ◦ To improve physician confidence when
      working with a patient experiencing pain
    ◦ To use drug calculations when making
      opioid decisions
    ◦ To write appropriate orders




                             http://zotzine.uci.edu/2009_04/patient.php
Assessing a Patient with Pain
 •   Describe the Pain Scale Appropriately
 •   Ask patient of history of addiction
 •   Discuss addiction vs. dependence
 •   Ask about opioid related side effects
 •   Assess for constipation
 •   Address the fear of addiction
 •   Make correct doses
Results

 More comfortable with making
   dosage decisions
 Increase in confidence
                             http://blog.soliant.com/doctor-and-physician-salary-
                             ranges-average-salaries-and-educational-
                             requirements/




 More frequent use of opioid conversions
 Not much effect on writing appropriate
  orders
Improving Results in the
      Future
            Continuous education and regular
             review will continue to improve
             resident physician skills




http://www.thedoctorweighsin.com/%E2%80%9Ctake-this-medication-okay-taking-a-look-at-emergency-department-discharge-instructions/
Acknowledgements
   I would like to thank Ms. Emily Shaw,
    Ms. Kat Walker, and all of the other
    staff at the Simulation Center for
    helping to make this project possible

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Pain Management FINAL

  • 1. Creating Better Pain Management through Clinical Simulation Hollie Adejumo Howard High School
  • 2. What is Pain? An "unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage.“ -The International Association for the Study of Pain http://health.howstuffworks.com/diseases-conditions/pai
  • 3. Types of Pain  Acute or Transient pain  Chronic or Persistent Pain  Cancer Pain http://health.howstuffworks.com/diseases-conditions/headache/10- types-of-headaches.htm
  • 4. Methods of Managing Pain • Internal Procedures • Medication • Therapy • Alternative Therapies • Counseling and Support Acupuncture is a common alternative method for relieving pain http://health.howstuffworks.com/wellness/natural-medicine/chinese/acupuncture.htm
  • 5. Measuring Pain “Pain is whatever the experiencing patient says it is, existing when she/he says it does” –McCaffery and Pasero (1999)  Patient’s Perspective: ◦ Demands physical, emotional, and mental energy  Provider’s Perspective: ◦ Assessed by looking at a patient’s report, not the predicted signs and symptoms ◦ Patients tells if pain is present and what it is like
  • 6. Types of Pain Medication  Non-Opioid Analgesics  Opioid Analgesics
  • 7. Effective Pain Management http://www.wllc.com/blog/preventing-medication-errors.cfm  Combine opioid and non-opioid pharmaceuticals  Timely administration
  • 8. Patient Concerns  Psychological Dependence  Drug Tolerance  Physical Dependence  Addiction
  • 9. Effective Pain Management and Considerations  Understand a patient’s cultural differences in pain expression ◦ Different cultures may have different ideas of the meaning of pain  Assess the meaning of pain to a patient
  • 10. Pain Assessment Tools  OPQRSTU  Pain Scales http://savvypatient.org
  • 11. OPQRSTU of Pain Assessment O nset P rovocative/Palliative Factors Q uality (Open Ended Questions) R egion/Radiation S everity Timing U You “How does pain affect you?”
  • 12. Pain Scales  Numerical Rating  Wong-Baker  Verbal Rating  Observer Scales
  • 13. Numerical Rating Scale http://understandingpain.wordpress.com/category/pain-assessment-tools/
  • 14. Wong-Baker Scale http://understandingpain.wordpress.com/category/pain-assessment-tools/
  • 15. Verbal Rating Scale- McGill Pain Questionnaire http://pain.about.com/od/testingdiagnosis/ig/pain-scales/McGill-Pain-Scale.htm
  • 16. Observer Pain Scales http://0.tqn.com/d/pain/1/0/V/-/-/-/FLACC.gif
  • 17. Using Pain Scales to Make Decisions about Pain Medication  Pain Scales make the pain measurable  Helps to determine if pain is mild, moderate, or severe  Makes it easier to find an effective dose
  • 18. Factors Considered when Determining Medication Dosage • History of a patient’s pain • Pain intensity • Duration of Pain • Aggravating and Relieving Conditions • Determine the cause of the pain
  • 19. Clinical Simulation-Based Training  “Simulation is a technique – not a technology – to replace or amplify real experiences with guided experiences that evoke or replicate substantial aspects of the real world in a fully interactive manner.” – David M. Gaba, Stanford University  Examples: ◦ Standardized Patients ◦ Mannequins ◦ Computer-Based Simulation Used to build a safer health system by providing guided practice http://blog.hospitalclinic.org/en/2009/05/nou-laboratori-de-simulacio- clinica-de-la-facultat-de-medicina/
  • 20. Benefits of Clinical Simulation http://www.temple.edu/ics/programs/medicine/fy2.html • Provides a variety of real-life situations • Opportunity to repeatedly practice without real patients • Convenient • Active learning and Concentration • Increases collaboration within medical teams
  • 21. Standardized Patient •An actor trained to portray the role of a patient, family member, or another individual •Simulate in a standardized manner http://www.temple.edu/ics/about/standardized.ht ml http://www.hopkinsmedicine.org/simulation_center/training/standardized_patient_program/index. html
  • 22. Resident Problems with Opioid Decision Making  Lack of Confidence  Poor Interviewing Technique  Lack of Opioid Knowledge  Poor written orders for medication  Inconsistent use of drug calculations to determine drug doses
  • 23. Improving Opioid Decision Making with Clinical Simulation- Based Training  Goals: ◦ To improve physician confidence when working with a patient experiencing pain ◦ To use drug calculations when making opioid decisions ◦ To write appropriate orders http://zotzine.uci.edu/2009_04/patient.php
  • 24. Assessing a Patient with Pain • Describe the Pain Scale Appropriately • Ask patient of history of addiction • Discuss addiction vs. dependence • Ask about opioid related side effects • Assess for constipation • Address the fear of addiction • Make correct doses
  • 25. Results  More comfortable with making dosage decisions  Increase in confidence http://blog.soliant.com/doctor-and-physician-salary- ranges-average-salaries-and-educational- requirements/  More frequent use of opioid conversions  Not much effect on writing appropriate orders
  • 26. Improving Results in the Future  Continuous education and regular review will continue to improve resident physician skills http://www.thedoctorweighsin.com/%E2%80%9Ctake-this-medication-okay-taking-a-look-at-emergency-department-discharge-instructions/
  • 27. Acknowledgements  I would like to thank Ms. Emily Shaw, Ms. Kat Walker, and all of the other staff at the Simulation Center for helping to make this project possible